Healthcare Provider Details

I. General information

NPI: 1679190078
Provider Name (Legal Business Name): BEHAVIORAL MULTIDISCIPLINARY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 SIMPSON RD
KISSIMMEE FL
34744-4600
US

IV. Provider business mailing address

2840 WILLOWSEED LN
SAINT CLOUD FL
34772-9364
US

V. Phone/Fax

Practice location:
  • Phone: 321-947-8923
  • Fax: 407-307-2328
Mailing address:
  • Phone: 321-947-9220
  • Fax: 407-307-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARIELY COLON
Title or Position: CLINICAL DIRECTOR
Credential: PH.D, LMHC, MBA
Phone: 407-541-7965